Individual
JASON LEE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MASSAGE THERAPIST
Contact information
Practice address
11120 NE HALSEY ST, PORTLAND, OR 97220-2021
(503) 252-5097
Mailing address
15420 SW MICA LN, BEAVERTON, OR 97007-9307
(503) 453-4991
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
12553
OR
Other
Enumeration date
12/04/2008
Last updated
12/04/2008
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